Equity-Related Factors in Emergency Medical Service Use for Acute Coronary Syndromes: A Systematic Review.
- 1Institute of Health & Sport, Victoria University, Melbourne, Victoria, Australia.
- 2School of Nursing & Midwifery, Centre for Quality & Patient Safety Research in the Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia.
Abstract
Background
Emergency medical service (EMS) use reduces time to treatment and improves outcomes in acute coronary syndrome (ACS), yet it is unknown whether all Australians have equitable access to EMS. This systematic review examined whether equity-related factors are associated with disparities in EMS use for patients with ACS in Australia.Methods
The review was pre-registered with PROSPERO (CRD42023466951). Six databases (MEDLINE, CINAHL, Web of Science, ScienceDirect, Cochrane and Scopus) were searched in June 2025 for articles published from inception until May 2025. Eligible studies involved adults presenting to Australian hospitals or emergency departments with ACS or acute non-traumatic chest pain and reported EMS use by at least one PROGRESS-Plus equity-related factor. Risk of bias was assessed using JBI checklists. Findings were synthesized using tabular analysis and a vote-counting summary.Results
Fourteen studies were identified, with twelve rated high quality. EMS utilization ranged from 36% to 79% and increased over time. Disparities were evident across multiple equity-related factors. Adults aged under 49 years had up to 68% lower odds of EMS use than those 65 years or older. Men had up to 11% lower odds than women. People born outside Australia had up to 15% lower odds, and those preferring non-English languages had 6-20% lower odds. Residents of remote areas had up to 25% lower odds than major city residents, while individuals living alone had up to 48% higher odds than those living with others. Findings for socioeconomic status measures were mixed.Conclusion
EMS use for ACS in Australia is consistently lower among younger adults, men, people born overseas, those preferring non-English languages, and residents of remote areas. These findings can inform targeted interventions to improve EMS accessibility. Future research should examine the mechanisms underlying these access barriers, particularly for populations experiencing multiple forms of disadvantage.
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BibTeX
@article{mcinnes2026equityrelated,
title = {{Equity-Related Factors in Emergency Medical Service Use for Acute Coronary Syndromes: A Systematic Review.}},
author = {Meg McInnes and Debra Kerr and Alan Hayes},
journal = {Open access emergency medicine : OAEM},
year = {2026},
month = oct,
doi = {10.2147/oaem.s628784},
url = {https://europepmc.org/article/MED/42904228},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Equity-Related Factors in Emergency Medical Service Use for Acute Coronary Syndromes: A Systematic Review.
AU - Meg McInnes
AU - Debra Kerr
AU - Alan Hayes
PY - 2026
DA - 2026/10/16
JO - Open access emergency medicine : OAEM
DO - 10.2147/oaem.s628784
UR - https://europepmc.org/article/MED/42904228
AB - Background Emergency medical service (EMS) use reduces time to treatment and improves outcomes in acute coronary syndrome (ACS), yet it is unknown whether all Australians have equitable access to EMS. This systematic review examined whether equity-related factors are associated with disparities in EMS use for patients with ACS in Australia.Methods The review was pre-registered with PROSPERO (CRD42023466951). Six databases (MEDLINE, CINAHL, Web of Science, ScienceDirect, Cochrane and Scopus) were searched in June 2025 for articles published from inception until May 2025. Eligible studies involved adults presenting to Australian hospitals or emergency departments with ACS or acute non-traumatic chest pain and reported EMS use by at least one PROGRESS-Plus equity-related factor. Risk of bias was assessed using JBI checklists. Findings were synthesized using tabular analysis and a vote-counting summary.Results Fourteen studies were identified, with twelve rated high quality. EMS utilization ranged from 36% to 79% and increased over time. Disparities were evident across multiple equity-related factors. Adults aged under 49 years had up to 68% lower odds of EMS use than those 65 years or older. Men had up to 11% lower odds than women. People born outside Australia had up to 15% lower odds, and those preferring non-English languages had 6-20% lower odds. Residents of remote areas had up to 25% lower odds than major city residents, while individuals living alone had up to 48% higher odds than those living with others. Findings for socioeconomic status measures were mixed.Conclusion EMS use for ACS in Australia is consistently lower among younger adults, men, people born overseas, those preferring non-English languages, and residents of remote areas. These findings can inform targeted interventions to improve EMS accessibility. Future research should examine the mechanisms underlying these access barriers, particularly for populations experiencing multiple forms of disadvantage.
SN - 1179-1500
ER -